What is the Plan for Regional Primary Maternity Units in Queensland?

Following the Rural Maternity Summit held in Longreach in April 2025, NASOG has become aware of a potential new model of care allowing Primary Maternity Units (PMUs) in Level 2 facilities to provide intrapartum care in the absence of onsite obstetricians, anaesthetists, paediatricians or specially credentialed general practitioners.

We understand that if this model were implemented, births could occur in facilities up to 200 kilometres away from the nearest Level 3 hospital, with retrieval services providing coverage in the event of complications.

We are sharing our concern about this proposal nationally as recent years have shown that Queensland has been the origin of a variety of changes to Scope of Practice in the healthcare system. Changes that have later been implemented nationally.

NASOG members and colleagues across the health system, including GPs, anaesthetists, retrieval specialists and midwives, and leading representative organisations should question the implementation of any system that puts the health and wellbeing of mothers and babies at risk.

Key Concerns with the Proposed Model

Clinical Risk and Complexity Misalignment

1. Labour and birth are dynamic processes. Intrapartum complications such as shoulder dystocia, obstructed labour, fetal distress or maternal haemorrhage can occur in any pregnancy—regardless of the initial risk classification.

2. These scenarios require timely access to surgical intervention and neonatal resuscitation that exceeds Level 3 capabilities. Redirecting these cases to Level 3 facilities risks overwhelming their capacity and compromises clinical safety.

Retrieval Limitations

1. The assumption that a single retrieval team can be deployed effectively over a 200km radius does not align with operational realities. Many of these cases would require dual retrieval teams (maternity and neonatal), and in-labour transfers are widely recognised as unsafe.

2. Distance and delay remain among the greatest predictors of maternal and perinatal harm.

Systemic Burden on Receiving Hospitals

1. The anticipated shift in risk burden will strain already stretched nursery services, theatre availability, and specialist rosters in regional and urban centres.

2. This will lead to displacement of elective procedures, burnout of specialist staff and in some cases, loss of workforce in rural communities, where continuity of care is already fragile.

Psychological and Community Harm

1. Instances of critical events occurring in underserviced settings—particularly in isolated communities—carry lasting trauma for clinicians, families and whole communities.

2. These risks cannot be justified by access alone. We echo the sentiment that access must not come at the expense of safety.

   
   

Call for Clarification, Transparency and Consultation

Given the magnitude of potential change in Queensland’s maternity system, NASOG has formally requested:

• A clear statement from the Minister for Health, Director-General and Deputy Directors-General confirming (or otherwise) any scope, timeline and risk management strategies for this model.

• Full publication of the policy documents presented at the Longreach Summit.

• Stakeholder engagement sessions with Heads of Department, retrieval services and frontline clinicians prior to any rollout.

• A detailed operational plan addressing retrieval workforce, infrastructure requirements and delineation of escalation pathways for intrapartum transfer.

A Shared Commitment to Rural Families

We are well aware of the difficult trade-offs involved in ensuring birthing access in rural and remote Queensland. However, access alone is not care. A birthing service without the capacity to safely manage common emergencies does not meet the threshold of safe healthcare.

Queensland families in rural and regional areas deserve better. They deserve continuity of care, safe clinical environments and a system that treats their lives and futures with the same level of caution and care as those in metropolitan centres.

NASOG has asked that Queensland Health consults with clinical leaders before progressing any implementation of this service. We are ready to assist and contribute to a framework that protects safety, supports workforce and delivers care with equity and excellence.

If you are worried about this kind of proposed model for maternity care in the bush, join our call for clarification and full consultation on the future of Primary Maternity Units.

A/Prof Gino Pecoraro, President

Dr Elizabeth Jackson, Vice President